The disruptive and lingering effects of conflict on health services provision-deficient health personnel, damaged health infrastructure, inadequate healthcare coordination, and weak supply chains-contribute to increased vulnerability to adverse outcomes related to these complications. Their occurrence is often unpreventable, unforeseeable, and expected in about 15% of women during pregnancy, childbirth, and the immediate postpartum. These complications, including haemorrhage, hypertensive disorders, sepsis, obstructed labour, complications of abortion, and intrapartum related asphyxia, cause most maternal deaths, stillbirths, and early neonatal deaths. The EmONC life-saving services, or signal functions, define 2 types of complementary health facilities based on their capacity to provide, within a 3-month period, the 7 basic signal functions or all 9 signal functions when pregnancy- and childbirth-related complications occur (see Table 1). Accordingly, it is of vital importance to improve access to quality EmONC in conflict-affected settings through data-driven programming. Some have argued that reduced availability/low quality of EmONC services is ‘the single most important factor implicated in maternal deaths in conflict and post-conflict settings’(12). Research shows that conflict disproportionately affects maternal and child health, both during and years after it has ended, and that many of the countries where most maternal and child deaths occur are experiencing or have emerged from conflict. Most of these countries are located in sub-Saharan Africa (SSA), a region that has witnessed the majority of armed conflicts over the past 3 decades. Particular attention to basic EmONC is required, focusing on strengthening human resources, equipment, supply chains, and referral capacity, on the one hand, and on tackling residual insecurity that might hinder 24/7 staff availability, on the other.Įmergency obstetric and newborn care (EmONC) is globally recognized as an essential health package for reducing preventable maternal and neonatal mortality, particularly in countries with persistently higher mortality rates. This study provides grounds for the development of coordinated and evidence-based programming, involving local and external stakeholders, as part of the post-conflict effort to address maternal and neonatal morbidity and mortality in the NKP. Overall, the intrapartum and very early neonatal death rate was 1.5%. However, the proportion the proportion of births by caesarean section in EmONC facilities was within acceptable range in the HZs of Goma and Rutshuru. The met need for EmONC was very low and the direct obstetric case fatality rate exceeded the maximum acceptable level. The 3 HZs fell short of WHO standards for the use and quality of EmONC. Assisted vaginal delivery was the least performed signal function, followed by parenteral administration of anticonvulsants, mainly due to policy restrictions and lack of demand. The number of functioning EmONC per 500,000 population was 1.5. None of the health centres qualified as basic EmONC, nor could they offer EmONC services 24 h, 7 days a week (24/7). Only three referral facilities (two faith-based facilities in Goma and the MSF-supported referral hospital of Rutshuru) met the criteria for comprehensive EmONC. Interviews, reviews of maternity ward records, and observations were used to assess the accessibility, use, and quality of EmONC against WHO standards. MethodĪ cross-sectional survey of all 42 public facilities designated to provide EmONC in 3 purposively selected HZs in the NKP (Goma, Karisimbi, and Rutshuru) was conducted in 2017. We assessed the availability, use, and quality of EmONC in 3 health zones (HZs) of the NKP to contribute to informed policy and programming in improving maternal and newborn health (MNH) in the region. In the North Kivu Province (NKP), the epicentre of armed conflict in eastern Democratic Republic of the Congo (DRC) between 20, the post-conflict status of EmONC is unknown. In such settings, assessment of EmONC is essential for data-driven interventions needed to reduce preventable maternal and neonatal mortality. Part of the blame lies with continued disruption to vital care provision, especially emergency obstetric and newborn care (EmONC). Pregnancy-related mortality remains persistently higher in post-conflict areas.
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